City Faltering On Public Health

Commissioner`s Job On Line, But Quick Cure Unlikely

January 30, 1989|By Jean Latz Griffin, Public health writer.

Health Commissioner Lonnie Edwards says he often wakes up at 2 in the morning worrying about the health problems that plague Chicago.

If most of the mayoral candidates have their way, Edwards will get a lot more sleep after the April 4 election. Every major candidate except Mayor Eugene Sawyer has vowed to fire him, and even Sawyer has said that ``all department heads will be evaluated after the election.``

The soft-spoken health commissioner`s belief that people`s behaviors are most often the cause of their diseases has put him at odds with activists who want the Health Department to take a more forceful role in combating AIDS, lead poisoning and infant mortality. But Edwards is more a convenient target than a major cause of the city`s health problems.

Whoever becomes the next mayor of Chicago in April will face a morass of health concerns that have their roots in the poverty and hopelessness of many of Chicago`s neighborhoods, the greed of organized medicine and the ill-thought-out efforts of cost analysts and politicians to scrimp on tax dollars for health care while ignoring the problems such frugality may cause. Among the concerns the next mayor faces are these:

- Chicago has an infant mortality rate of 16.6 deaths per 1,000 births, higher than most industrialized nations. The rate for black infants, 22.9, is as high as that of several Third World countries. The infant mortality rate is seen by health experts as a key indicator of the state of health of women and children in an area.

- The city`s aging housing stock, with its crumbling, flaking lead-based paint, contributes to the poisoning and subsequent learning and behavior problems of an estimated 5,000 to 12,000 children a year. Chicago ranks below other major cities in its efforts to protect children from lead poisoning.

- Caught between a growing underclass and rigid budget restraints on medical care for the poor, the city has watched 10 hospitals close for financial reasons in the last three years, primarily in poor and minority neighborhoods.

- The single public hospital is run not by the city but by Cook County, even though most of the people who use it live in the city. That makes the politics of providing health care in the city equivalent to negotiating mine fields in a war zone.

- The Chicago Department of Health, critics say, is a patronage-ridden haven that shortchanges the indigent patients it treats and botches the management of life-and-death programs, such as the troubled AIDS Activity Office. Removing Edwards while leaving the department as it is will do little to improve things, say health experts and political observers.

``The Health Department has the highest profile gap in city government between the skills and services that are needed and what is actually done because of patronage,`` said Daniel Schwartzman, assistant professor of health management at the University of Illinois-Chicago School of Public Health.

Schwartzman criticized the department`s over-reliance on education techniques ``that blame the victim rather than examine society`s role in prevention.``

``The AIDS and smoking billboards,`` he said, ``are just a way of having something really big to hide the problem behind.``

Democratic candidates State`s Atty. Richard M. Daley and Ald. Lawrence Bloom (5th), and Dr. Herbert Sohn, a Republican candidate in the Feb. 28 primary, have said they not only will fire Edwards but will professionalize the Health Department ``from the top down.``

Daley devoted an entire week to discussing health issues and proposed some creative solutions to key problems, such as setting up a ``prenatal express,`` in which poor women would get free rides on CTA buses to city health clinics.

Bloom is in the process of developing a position paper on health. The draft, a 25-page ``blueprint for Chicago,`` calls for leadership to develop long-range plans for health care in Chicago.

Ald. Timothy Evans (4th), whose wife is a physician and who plans to be an independent candidate in April, said he would develop cooperative efforts between the city and the county to deal with the area`s ``rampant health problems.``

Public health officials say such planning and cooperation is crucial but will be difficult because of competing political interests.

``Health care in Chicago is not even a patchwork system,`` Schwartzman said. ``It is Balkanization of government services. Everybody has their own little fiefdom.``

Schwartzman, an attorney who has worked in political campaigns, contends that Chicago politics is a throwback to feudalism, with kings, barons and peasants.

``We have this mess in health care because it doesn`t pay any one baron enough to coordinate the system for the entire region,`` Schwartzman said.

``Someone would have to give up control and jobs for the good of the whole, and no one is about to do that.``